
<style>
.select2-dropdown {
	z-index: 20000000;
}
</style>
<!-- <div class="layer_container">
	<div class="body_container no-footer" style="overflow-y: auto;overflow-x: hidden;"> -->
		<form id="patient_form_info">
			<input type="hidden" name = "vaa01" value="{{d.vaa01}}" />
			<input type="hidden" name = "vac01" value="{{d.vac01}}" />
			<input type="hidden" name = "bce03" value="{{d.bce03}}" />
			<input type="hidden" name = "bce01" value="{{d.bce01}}" />
		</form>
		<form id="check_form_info">
			<div id="allfield">
				<div class="eye-jiancha-info ">
					<div class="hospital-info-content form-inline">
						<div class="info-group info-group-horizontal" style="width:100%;margin: 5px 25px;">
							<div class="row key_control_div ">
								<div class="info-group-head">
									<div class="info-group-item-title">
										<span class="info-required must"></span> <span class="name">视力</span>
									</div>
		
								</div>
								<div class="info-table-item" style="height: 122px;">
									<div class="main-content-table">
										<div class="main-table-container" id="">
											<table id="shili_table"
												class="table-responsive table table-hover table-striped table-border ">
												<thead>
													<tr>
														<td style="width: 100px;">眼别</td>
														<td>远</td>
														<td>近</td>
														<td>配镜</td>
														<td>矫正</td>
														<td>小孔</td>
													</tr>
												</thead>
												<tbody>
													<tr data-item="eye03">
														<td>OD</td>
														<td class=" input-td" value='1'>
														<input class="form-input keycontrol" type="text" name="EYE01" /></td>
														<td class=" input-td" value='2'><input
															class="form-input keycontrol" type="text"  name="EYE02" /></td>
														<td class=" input-td" value='3'><input
															class="form-input keycontrol" type="text"   name="EYE03" /></td>
														<td class=" input-td" value='4'><input
															class="form-input keycontrol" type="text"  name="EYE04" /></td>
														<td class=" input-td" value='5'><input
															class="form-input keycontrol" type="text"  name="EYE05" /></td>
													</tr>
													<tr data-item="eye04">
														<td>OS</td>
														<td class=" input-td" value='1'><input
															class="form-input keycontrol" type="text"  name="EYE06" /></td>
														<td class=" input-td" value='2'><input
															class="form-input keycontrol" type="text"  name="EYE07" /></td>
														<td class=" input-td" value='3'><input
															class="form-input keycontrol" type="text"  name="EYE08" /></td>
														<td class=" input-td" value='4'><input
															class="form-input keycontrol" type="text"  name="EYE09" /></td>
														<td class=" input-td" value='5'><input
															class="form-input keycontrol" type="text"  name="EYE10" /></td>
													</tr>
		
												</tbody>
											</table>
										</div>
		
									</div>
								</div>
		
							</div>
							
							<div class="row list-unstyled key_control_div ">
								<li class="info-group-head">
									<div class="info-group-item-title">
										<span class="info-required must"></span> <span class="name">眼压</span>
									</div>
		
								</li>
								<li class="info-group-item key_control_div">
									<div class="info-group-item-title">
										<span class="info-required "></span> <span>OD</span>
									</div>
									<div class="info-group-item-input">
										<div class="input-group">
											<input class="form-input keycontrol" id="" name="EYE11">
											<div class="input-group-btn">
												<button class="btn  btn-min btn-white" type="button">mmHg</button>
											</div>
										</div>
									</div>
								</li>
								<li class="info-group-item key_control_div">
									<div class="info-group-item-title">
										<span class="info-required "></span> <span>OS</span>
									</div>
									<div class="info-group-item-input">
										<div class="input-group">
											<input class="form-input keycontrol" id="" name="EYE12">
											<div class="input-group-btn">
												<button class="btn  btn-min btn-white" type="button">mmHg</button>
											</div>
										</div>
									</div>
								</li>
							</div>
							<div class="row list-unstyled key_control_div ">
								<li class="info-group-head">
									<div class="info-group-item-title">
										<span class="info-required must"></span> <span class="name">泪液分泌试验</span>
									</div>
		
								</li>
								<li class="info-group-item key_control_div">
									<div class="info-group-item-title">
										<span class="info-required "></span> <span>OD</span>
									</div>
									<div class="info-group-item-input">
										<div class="input-group">
											<input class="form-input keycontrol" id="" name="EYE13">
											<div class="input-group-btn">
												<button class="btn  btn-min btn-white" type="button">&nbsp;&nbsp;
													mm&nbsp;&nbsp;</button>
											</div>
										</div>
									</div>
								</li>
								<li class="info-group-item key_control_div">
									<div class="info-group-item-title">
										<span class="info-required "></span> <span>OS</span>
									</div>
									<div class="info-group-item-input">
										<div class="input-group">
											<input class="form-input keycontrol" id="" name="EYE14">
											<div class="input-group-btn">
												<button class="btn  btn-min btn-white" type="button">&nbsp;&nbsp;
													mm&nbsp;&nbsp;</button>
											</div>
										</div>
									</div>
								</li>
							</div>
							<div class="row list-unstyled key_control_div ">
								<li class="info-group-head">
									<div class="info-group-item-title">
										<span class="info-required must"></span> <span class="name">压陷式眼压</span>
									</div>
		
								</li>
								<li class="info-group-item key_control_div">
									<div class="info-group-item-title">
										<span class="info-required "></span> <span>OD</span>
									</div>
									<div class="info-group-item-input">
										<div class="input-group">
											<input class="form-input keycontrol" id="" name="EYE57">
											<div class="input-group-btn">
												<button class="btn  btn-min btn-white" type="button">mmHg</button>
											</div>
										</div>
									</div>
								</li>
								<li class="info-group-item key_control_div">
									<div class="info-group-item-title">
										<span class="info-required "></span> <span>OS</span>
									</div>
									<div class="info-group-item-input">
										<div class="input-group">
											<input class="form-input keycontrol" id="" name="EYE58">
											<div class="input-group-btn">
												<button class="btn  btn-min btn-white" type="button">mmHg</button>
											</div>
										</div>
									</div>
								</li>
							</div>
							<div class="row list-unstyled key_control_div">
								<li class="info-group-head">
									<div class="info-group-item-title">
										<span class="info-required must"></span> <span class="name">眼球突出</span>
									</div>
		
								</li>
								<li class="info-group-item key_control_div">
									<div class="info-group-item-title">
										<span class="info-required "></span> <span>OD</span>
									</div>
									<div class="info-group-item-input">
										<div class="input-group">
											<input class="form-input keycontrol" id="eye11" name="EYE59">
											<div class="input-group-btn">
												<button class="btn  btn-min btn-white" type="button">&nbsp;&nbsp;
													mm&nbsp;&nbsp;</button>
											</div>
										</div>
									</div>
								</li>
								<li class="info-group-item key_control_div">
									<div class="info-group-item-title">
										<span class="info-required "></span> <span>OS</span>
									</div>
									<div class="info-group-item-input">
										<div class="input-group">
											<input class="form-input keycontrol" id="eye12" name="EYE60">
											<div class="input-group-btn">
												<button class="btn  btn-min btn-white" type="button">&nbsp;&nbsp; mm&nbsp;&nbsp;</button>
											</div>
										</div>
									</div>
								</li>
								<li class="info-group-item key_control_div">
									<div class="info-group-item-title">
										<span class="info-required "></span> <span>距离</span>
									</div>
									<div class="info-group-item-input">
										<div class="input-group">
											<input class="form-input keycontrol" id="" name="EYE94">
											<div class="input-group-btn">
												<button class="btn  btn-min btn-white" type="button">&nbsp;&nbsp; cm&nbsp;&nbsp;</button>
											</div>
										</div>
									</div>
								</li>
							</div>
							
							
							
							<div class="row key_control_div ">
								<div class="info-group-head">
									<div class="info-group-item-title">
										<span class="info-required must"></span> <span class="name">体温</span>
									</div>
		
								</div>
								<div class="info-table-item" style="height: 83px;">
									<div class="main-content-table">
										<div class="main-table-container" id="stata_List_grid_content">
											<table id="shili_table"
												class="table-responsive table-change table table-hover table-striped table-border ">
												<thead>
													<tr>
														<td>时间</td>
														<td>℃</td>
														<td>时间</td>
														<td>℃</td>
														<td>时间</td>
														<td>℃</td>
													</tr>
												</thead>
												<tbody>
													<tr>
														<td class=" input-td">
														<input type="text" id="" name="EYE15" 
														class="form-input date-input  keycontrol" value="" />
														</td>
														<td class=" input-td">
														 	<input class="form-input keycontrol" type="text"  name="EYE16" />
														 </td>
															<td class=" input-td" >
														<input type="text" id="" name="EYE17" 
														class="form-input date-input  keycontrol" value="" />
														</td>
														<td class=" input-td" >
														 	<input class="form-input keycontrol" type="text"  name="EYE18" />
														 </td>
														 	<td class=" input-td">
														<input type="text" id="" name="EYE19" 
														class="form-input date-input  keycontrol" value="" />
														</td>
														<td class=" input-td" >
														 	<input class="form-input keycontrol" type="text"  name="EYE20" />
														 </td>
													</tr>
												</tbody>
											</table>
										</div>
		
									</div>
								</div>
		
							</div>
							<div class="row key_control_div ">
								<div class="info-group-head">
									<div class="info-group-item-title">
										<span class="info-required must"></span> <span class="name">呼吸</span>
									</div>
		
								</div>
								<div class="info-table-item" style="height: 83px;">
									<div class="main-content-table">
										<div class="main-table-container" id="stata_List_grid_content">
											<table id="shili_table"
												class="table-responsive table-change table table-hover table-striped table-border ">
												<thead>
													<tr>
														<td>时间</td>
														<td>次/分</td>
														<td>时间</td>
														<td>次/分</td>
														<td>时间</td>
														<td>次/分</td>
													</tr>
												</thead>
												<tbody>
													<tr>
														<td class=" input-td" >
														<input type="text" id="" name="EYE33" 
														class="form-input date-input  keycontrol" value="" />
														</td>
														<td class=" input-td" >
														 	<input class="form-input keycontrol" type="text"  name="EYE34" />
														 </td>
															<td class=" input-td" >
														<input type="text" id="" name="EYE35" 
														class="form-input date-input  keycontrol" value="" />
														</td>
														<td class=" input-td" >
														 	<input class="form-input keycontrol" type="text"  name="EYE36" />
														 </td>
														 	<td class=" input-td" >
														<input type="text" id="" name="EYE37" 
														class="form-input date-input  keycontrol" value="" />
														</td>
														<td class=" input-td" value='2'>
														 	<input class="form-input keycontrol" type="text"  name="EYE38" />
														 </td>
													</tr>
												</tbody>
											</table>
										</div>
		
									</div>
								</div>
		
							</div>
							<div class="row key_control_div ">
								<div class="info-group-head">
									<div class="info-group-item-title">
										<span class="info-required must"></span> <span class="name">脉搏</span>
									</div>
		
								</div>
								<div class="info-table-item" style="height: 83px;">
									<div class="main-content-table">
										<div class="main-table-container" id="stata_List_grid_content">
											<table id="shili_table"
												class="table-responsive table-change table table-hover table-striped table-border ">
												<thead>
													<tr>
														<td>时间</td>
														<td>次/分</td>
														<td>时间</td>
														<td>次/分</td>
														<td>时间</td>
														<td>次/分</td>
													</tr>
												</thead>
												<tbody>
													<tr>
														<td class=" input-td">
														<input type="text" id="" name="EYE21" 
														class="form-input date-input  keycontrol" value="" />
														</td>
														<td class=" input-td" >
														 	<input class="form-input keycontrol" type="text"  name="EYE22" />
														 </td>
															<td class=" input-td" >
														<input type="text" id="" name="EYE23" 
														class="form-input date-input  keycontrol" value="" />
														</td>
														<td class=" input-td" >
														 	<input class="form-input keycontrol" type="text"  name="EYE24" />
														 </td>
														 	<td class=" input-td">
														<input type="text" id="" name="EYE25"
														class="form-input date-input  keycontrol" value="" />
														</td>
														<td class=" input-td" value='2'>
														 	<input class="form-input keycontrol" type="text"  name="EYE26" />
														 </td>
													</tr>
												</tbody>
											</table>
										</div>
		
									</div>
								</div>
		
							</div>
							<div class="row key_control_div ">
								<div class="info-group-head">
									<div class="info-group-item-title">
										<span class="info-required must"></span> <span class="name">血压</span>
									</div>
		
								</div>
								<div class="info-table-item" style="height: 83px;">
									<div class="main-content-table">
										<div class="main-table-container" id="stata_List_grid_content">
											<table id="shili_table"
												class="table-responsive table-change table table-hover table-striped table-border ">
												<thead>
													<tr>
														<td>时间</td>
														<td>mmHg</td>
														<td>时间</td>
														<td>mmHg</td>
														<td>时间</td>
														<td>mmHg</td>
													</tr>
												</thead>
												<tbody>
													<tr>
														<td class=" input-td">
														<input type="text" id="" name="EYE27" 
														class="form-input date-input  keycontrol" value="" />
														</td>
														<td class=" input-td" >
														 	<input class="form-input keycontrol" type="text"  name="EYE28" />
														 </td>
															<td class=" input-td">
														<input type="text" id="" name="EYE29" 
														class="form-input date-input  keycontrol" value="" />
														</td>
														<td class=" input-td" >
														 	<input class="form-input keycontrol" type="text"  name="EYE30" />
														 </td>
														 	<td class=" input-td" >
														<input type="text" id="" name="EYE31" 
														class="form-input date-input  keycontrol" value="" />
														</td>
														<td class=" input-td" >
														 	<input class="form-input keycontrol" type="text"  name="EYE32" />
														 </td>
													</tr>
												</tbody>
											</table>
										</div>
		
									</div>
								</div>
		
							</div>
							<div class="row key_control_div ">
								<div class="info-group-head">
									<div class="info-group-item-title">
										<span class="info-required must"></span> <span class="name">血糖</span>
									</div>
		
								</div>
								<div class="info-table-item" style="left:27px;height: 40px;">
									<div class="input-group">
									<input class="form-input keycontrol" id="EYE39_I" name="EYE39">
									<input type="hidden" id="EYE40_I" name="EYE40">
									<div class="input-group-btn">
										<select name="" id="EYE40_S" class="input-group-addon">
											<option value="1">空腹</option>
											<option value="2">餐后</option>
											<option value="3">随机</option>
										</select>
									</div>
								</div>
								</div>
		
							</div>
							<div class="row key_control_div ">
								<div class="info-group-head">
									<div class="info-group-item-title">
										<span class="info-required must"></span> <span class="name">睑板腺按摩</span>
									</div>
		
								</div>
								<div class="info-table-item" style="height: 164px;">
									<div class="main-content-table">
										<div class="main-table-container" id="stata_List_grid_content">
											<table id="leidao_table"
												class="table-responsive table table-hover table-striped table-border ">
												<thead>
													<tr>
														<td>眼别</td>
														<td>牙膏状</td>
														<td>黄色颗粒</td>
														<td>黄色液体</td>
														<td>白色颗粒</td>
														<td>白色液体</td>
													</tr>
												</thead>
												<tbody>
													<tr >
														<td>OD上</td>
														<td class="item_td" ><input name="EYE41" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE42" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE95" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE43" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE44" type="hidden" /><span>×</span></td>
													</tr>
													<tr >
														<td>OD下</td>
														<td class="item_td" ><input name="EYE45" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE46" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE96" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE47" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE48" type="hidden" /><span>×</span></td>
													</tr>
													<tr >
														<td>OS上</td>
														<td class="item_td" ><input name="EYE49" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE50" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE97" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE51" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE52" type="hidden" /><span>×</span></td>
													</tr>
													<tr data-item="eye20">
														<td>OS下</td>
														<td class="item_td" ><input name="EYE53" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE54" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE98" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE55" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE56" type="hidden" /><span>×</span></td>
													</tr>
												</tbody>
											</table>
										</div>
		
									</div>
								</div>
		
							</div>
							<div class="row key_control_div ">
								<div class="info-group-head">
									<div class="info-group-item-title">
										<span class="info-required must"></span> <span class="name">泪道冲洗</span>
									</div>
		
								</div>
								<div class="info-table-item" style="height: 200px">
									<div class="main-content-table">
										<div class="main-table-container" id="stata_List_grid_content">
											<table id="lianban_table"
												class="table-responsive table table-hover table-striped table-border ">
												<thead>
													<tr>
														<td>眼别</td>
														<td>进针是否用泪扩</td>
														<td>是否触及骨壁</td>
														<td>进针长度</td>
														<td>有夹针感</td>
														<td>对返</td>
														<td>原返</td>
														<td>能否推注</td>
														<td>分泌物及性质</td>
													</tr>
												</thead>
												<tbody>
													<tr data-item="eye13">
														<td>OD上</td>
														<td class="item_td" ><input name="EYE61" type="hidden" /><span>×</span></td>
														<td class="item_td"><input name="EYE65" type="hidden" /><span>×</span></td>
														<td class="input-td" ><input
															class="form-input keycontrol" type="text" name="EYE69" /></td>
														<td class="item_td input-td" ><input name="EYE73" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE77" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE81" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE85" type="hidden" /><span>×</span></td>
														<td class="input-td" ><input
															class="form-input keycontrol" type="text" name="EYE89" /></td>
													</tr>
													<tr data-item="eye14">
														<td>OD下</td>
														<td class="item_td" ><input name="EYE62" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE66" type="hidden" /><span>×</span></td>
														<td class="input-td" value='3'><input
															class="form-input keycontrol" type="text" name="EYE70" /></td>
														<td class="item_td" ><input name="EYE74" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE78" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE82" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE86" type="hidden" /><span>×</span></td>
														<td class="input-td" ><input
															class="form-input keycontrol" type="text" name="EYE90" /></td>
													</tr>
													<tr data-item="eye15">
														<td>OS上</td>
														<td class="item_td" ><input name="EYE63" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE67" type="hidden" /><span>×</span></td>
														<td class="input-td" ><input
															class="form-input keycontrol" type="text" name="EYE71" /></td>
														<td class="item_td" ><input name="EYE75" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE79" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE83" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE87" type="hidden" /><span>×</span></td>
														<td class="input-td" ><input
															class="form-input keycontrol" type="text" name="EYE91" /></td>
													</tr>
													<tr data-item="eye16">
														<td>OS下</td>
														<td class="item_td" ><input name="EYE64" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE68" type="hidden" /><span>×</span></td>
														<td class="input-td" ><input
															class="form-input keycontrol" type="text" name="EYE72" /></td>
														<td class="item_td" ><input name="EYE76" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE80" type="hidden" /><span>×</span></td>
														<td class="item_td"><input name="EYE84" type="hidden" /><span>×</span></td>
														<td class="item_td" ><input name="EYE88" type="hidden" /><span>×</span></td>
														<td class="input-td" ><input
															class="form-input keycontrol" type="text" name="EYE92" /></td>
													</tr>
												</tbody>
											</table>
										</div>
		
									</div>
								</div>
		
							</div>
						</div>
					</div>
				</div>
				</div>
		</form>
	</div>
</div>